Topic: Role of Tele-Medicine during and Post COVID

 9^th October, 2021, Saturday; 9.30am-11am

• The effect of the SARS-CoV-2 appears to have crossed the peak, but the virus is notorious for changing its form from time to time. Various vaccines are available, but their efficacy is not complete. Its temporary. Social distancing is a primary measure to prevent the infection. This is where telemedicine comes in.
• Telemedicine helps to triage the huge number of patients thereby reducing workload on doctors and institutions, keeps patients with chronic disease or noncovid patients away from hospitals preventing infections and healthcare workers provide online consultations, which keeps them away from infected patients.
• Healthcare workers (HCWs) who have been infected and are therefore quarantined can still provide consultations to the patients via telemedicine.
• Simply put, telemedicine is when doctors cannot meet patients and vice versa.
• Telemedicine is 1:1 doctor to patient. As technology evolved, medicine was replaced by health and the scope of telemedicine widened and the definition changed from telemedicine to telehealth. Now it is called digital health as it not only encompasses clinical medicine but also nonclinical practices including research.
• With Covid pandemic, telemedicine is here to stay. Now the care will be a hybrid form of care.
• Space telemedicine will also evolve.
• We need to be familiar with these changes and adapt to these changes.
• Technology is still unravelling and lot of new technology will soon come in.
• Till the consumers believe telemedicine to be dependable, credible and easy, it may not be easy to adopt.
• Telemedicine guidelines in India were released in March 2020. Telemedicine has to be standardized; there must be accountability, accreditation so that medical errors are reduced.
• Teleconsultation has been legalized in India.
• The first Covid patient in Pakistan was diagnosed on 26^th February in Punjab Mayo Hospital affiliated to King Edward Medical University. This was followed by a quick upsurge of cases in the country. Telemedicine was introduced in Pakistan by the Governor of Punjab, who called an emergent meeting of 5 VCs of five public sector universities in Punjab and within 10 hours this was started in King Edward Medical University. Four corona helpdesks were started. Initially queries from all parts of the province and the country were answered; the VC of King Edward Medical University extended these services to telehealth or tele OPD. OPDs were closed and tele OPD started. Three modes of communication were adopted: Skype, WhatsApp video calls and Landline. A proper biodata system was started for the patients. Now patients from any part of the world can get an appointment on the telemedicine webpage of King Edward Medical University. All prescriptions, radiographs etc. are available on the portal. Tele dengue, tele psychiatry and teledermatology were also introduced. This week about 14,000 calls were received; these are free of cost.
• Telemedicine allows a multidisciplinary approach to patients.
• Adaptation of telemedicine and telehealth is a big challenge. There is resistance among doctors in adopting telemedicine.
• Digital literacy among doctors needs to be addressed, especially in the post-pandemic period.
• The 2020 India guidelines require new practitioners to have taken an online course in telemedicine. Registration is not required for every state where the doctor wants to practice telemedicine. Telemedicine society of India has online courses in various specialties for training of doctors; about 25,000 doctors have been trained in telemedicine in India. The Indian government has developed e-Sanjivini, a robust platform for teleconsultations. The number of consultations has crossed 25 million, which is a milestone.
• There is a need to create awareness among consumers about the efficacy of telemedicine and attune them to use this facility.
• The reach of telemedicine is tremendous and so guidelines are very necessary for every country.
• Bangladesh government is formulating telemedicine guidelines and will also enact a law in this regard.
• Whether telemedicine contradicts the principle of privacy and confidentiality is a major issue.
• Can telemedicine be open to consultations from foreign countries? While patients outside the country can get a prescription, they cannot buy those medicines in the country they are residing in. So, they can only get an advice.
• Privacy and data security is a burning issue.
• India has introduced the Personal Data Protection Bill, but it is yet to be enacted.
• In Singapore, all doctors have to undertake an online telemedicine course, accredited by the Singapore Medical Council, before they can practice telemedicine. Telemedicine has become popular in the last few weeks because of the recent upsurge in the number of cases.
• The India telemedicine guidelines mandate that all registered medical practitioners intending to provide online consultation need to complete an online course and be certified in the same, within 3 years of issuance of the guidelines. IRDA has issued instructions to insurance companies to include teleconsultations within the ambit of reimbursement.
• Many more legal issues will come up in addition to data protection.
• Doctors need to know the scope of teleconsultation, what medicines can be prescribed etc. All these aspects need to be clearly defined to avoid legal hassles.
• The advantage of teleconsultation is that documentation is complete, video is complete and is available for evidence. Hence, there have been very few cases against teleconsultation as compared to face-to-face consultation.
• Telemedicine in the long run would be a safer medium for chronic care and for wound care on follow up.
• The telepresence avatar technology may soon become a reality, where the doctor can visit the patient while sitting in their office via telerobotics.
• Telemedicine is an enabler for good medical practice; it is not a total substitute.

Participants

Speakers: Dr Col Ashvini Goel, Dr Sunil Shroff, Dr SK Mishra, Prof Bejon Misra, Prof Bilquis Shabbir

Member National Medical Associations

Dr Yeh Woei Chong, Singapore, Chair CMAAO

Dr Ravi Naidu, Malaysia, Immediate Past President CMAAO

Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO

Dr Marthanda Pillai, India Member World Medical Council, Advisor CMAAO

Dr Wasiq Qazi, Pakistan, President-elect CMAAO

Dr Md Jamaluddin Chowdhury, Bangladesh

Dr Dong-Chun Shin, South Korea

Dr Angelique Coetzee, South Africa

Dr Akhtar Hussain, South Africa

Dr Salma Kundi, Pakistan

Dr Qaiser Sajjad, Pakistan

Dr Ashraf Nizami, Pakistan

Invitees

Dr Russell D’Souza, Australia UNESCO Chair in Bioethics

Dr Col Ashvini Goel, India

Dr Sunil Shroff, India

Dr SK Mishra, India

Prof Bejon Misra, India

Dr Yeo Khoonhui

Dr EC Ng

Dr Mulazim Hussain Bukhari, Pakistan

Dr Patricia La Brooyi

Dr S Sharma, Editor IJCP Group

Moderator

Mr Saurabh Aggarwal